Suspected CA GB at Lap Chole
| Discussion in 'All Categories' started by Avinash Kumar Singh - Jun 13th, 2016 11:47 am. | |
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Avinash Kumar Singh
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What should be our next step when we suspect CA GB while performing lap chole. Preop investigation USG and LFT if normal. |
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re: Suspected CA GB at Lap Chole
by Dr R K Mishra -
Jun 14th, 2016
9:51 am
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Dr R K Mishra
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Laparoscopic cholecystectomy does not affect survival if implemented properly even if this is found incidental finding during routine surgery. Reoperation should be done as soon as possible and have two objectives: R0 resection and clearance of the all affected lymph nodes. There are controversies exist on the optimal treatment of finding of CA GB during routine laparoscopic cholecystectomy. The management is challenging and difficult because there is no clear guidelines by WALS and overall prognosis may be bad when the patient was not adequately treated. If CA GB is diagnosed at an earlier preoperatively stage and MRCP, PET Scan and even CT guided biopsy is done then carries a better prognosis than non incidentally found cancer. Laparoscopic cholecystectomy done unknowingly does not affect survival if implemented with proper technique and it may be an adequate treatment for earlier stage CA GB: Tis and T1a. All other stages, starting from T1b should be treated with lymphadenectomy and resection of at least 2-3 cm of liver parenchyma around the liver bed by radical technique. |
